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Weber TC, Jewell M, Schulman CI, Morgan J, Lee AM, Olivier AK, Swanson EA. Minimally Invasive Beaded Electrosurgical Dissectors, Basic Science, and Pilot Studies. Aesthet Surg J Open Forum 2024; 6:ojae034. [PMID: 38938927 PMCID: PMC11210070 DOI: 10.1093/asjof/ojae034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2024] Open
Abstract
Background Minimally invasive beaded electrosurgical dissectors ("BEED devices") provide simultaneous sharp dissection, blunt dissection, and electrosurgical coagulation while performing 100 cm2 porcine tissue plane dissections in 0.8 to 3 min with minimal bleeding and no perforations. Objectives The aim of the study was to report the basic science and potential clinical applications and to video document the speed and quality of planar dissections in in vivo and ex vivo porcine models with thermal damage quantified by thermal and histopathologic measurements. Additionally, in vivo porcine specimens were followed for 90 days to show whether adverse events occurred on a gross or macroscopic basis, as evidenced by photography, videography, physical examination, and dual ultrasonography. Methods Ex vivo porcine models were subjected to 20, 30, and 50 W in single-stroke passages with BEED dissectors (granted FDA 510(k) clearance (K233002)) with multichannel thermocouple, 3 s delay recordation combined with matching hematoxylin and eosin (H&E) histopathology. In vivo porcine models were subjected to eight 10 × 10 cm dissections in each of 2 subjects at 20, 30, and 50 W and evaluated periodically until 90 days, wherein histopathology for H&E, collagen, and elastin was taken plus standard and Doppler ultrasounds prior to euthanasia. Results Five to 8 mm width dissectors were passed at 1 to 2 cm/s in ex vivo models (1-10 cm/s in vivo models) with an average temperature rise of 5°C at 50 W. Clinically evidenced seromas occurred in the undressed, unprotected wounds, and resolved well prior to 90 days, as documented by ultrasounds and histopathology. Conclusions In vivo and ex vivo models demonstrated thermal values that were below levels known to damage subcutaneous adipose tissue or skin. Tissue histopathology confirmed healing parameters while Doppler ultrasound demonstrated normal blood flow in posttreatment tissues. Level of Evidence 4
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Affiliation(s)
- Taiyo C Weber
- Corresponding Author: Mr Taiyo C. Weber, Otago Medical School, PO Box 56, Dunedin 9054, New Zealand. E-mail:
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Imai K, Hotta K, Ito S, Kishida Y, Takada K, Suwa T, Ashizawa H, Minamide T, Yamamoto Y, Yoshida M, Maeda Y, Kawata N, Sato J, Ishiwatari H, Matsubayashi H, Oishi T, Sugino T, Mori K, Ono H. A novel low-power pure-cut hot snare polypectomy for 10-14 mm colorectal adenomas: An ex vivo and a clinical prospective feasibility study (SHARP trial). J Gastroenterol Hepatol 2024; 39:667-673. [PMID: 38149747 DOI: 10.1111/jgh.16452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 11/10/2023] [Accepted: 12/03/2023] [Indexed: 12/28/2023]
Abstract
BACKGROUND AND AIM Hot snare polypectomy using blend or coagulation current is widely used; however, it causes deeper tissue heat injury, leading to adverse events. We hypothesized that hot polypectomy using low-power pure cut current (PureCut, effect 1 10 W) could reduce deeper tissue heat injury. We conducted animal experiments to evaluate the deeper tissue heat injury and conducted a prospective clinical study to examine its cutting ability. METHODS In a porcine rectum, hot polypectomy using Blend current (EndoCut, effect 3 40 W) and low-power pure cut current was performed. The deepest part of heat destruction and thickness of the non-burned submucosal layer were evaluated histologically. Based on the results, we performed low-power pure cut current hot polypectomy for 10-14 mm adenoma. The primary endpoint was complete resection defined as one-piece resection with negative for adenoma in quadrant biopsies from the defect margin. RESULTS In experiments, all low-power pure-cut resections were limited within the submucosal layer whereas blend current resections coagulated the muscular layer in 13% (3/23). The remaining submucosal layer was thicker in low-power pure cut current than in blend current resections. In the clinical study, low-power pure-cut hot polypectomy removed all 100 enrolled polyps. For 98 pathologically neoplastic polyps, complete resection was achieved in 84 (85.7%, 95% confidence interval, 77-92%). The lower limit of the 95% confidence interval was not more than 15% below the pre-defined threshold of 86.6%. No severe adverse events occurred. CONCLUSIONS A novel low-power pure-cut hot polypectomy may be feasible for adenoma measuring 10-14 mm. (UMIN000037678).
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Affiliation(s)
- Kenichiro Imai
- Division of Endoscopy, Shizuoka Cancer Center, Sunto-gun, Shizuoka, Japan
| | - Kinichi Hotta
- Division of Endoscopy, Shizuoka Cancer Center, Sunto-gun, Shizuoka, Japan
| | - Sayo Ito
- Division of Endoscopy, Shizuoka Cancer Center, Sunto-gun, Shizuoka, Japan
| | - Yoshihiro Kishida
- Division of Endoscopy, Shizuoka Cancer Center, Sunto-gun, Shizuoka, Japan
| | - Kazunori Takada
- Division of Endoscopy, Shizuoka Cancer Center, Sunto-gun, Shizuoka, Japan
| | - Tetsuya Suwa
- Division of Endoscopy, Shizuoka Cancer Center, Sunto-gun, Shizuoka, Japan
| | - Hiroshi Ashizawa
- Division of Endoscopy, Shizuoka Cancer Center, Sunto-gun, Shizuoka, Japan
| | - Tatsunori Minamide
- Division of Endoscopy, Shizuoka Cancer Center, Sunto-gun, Shizuoka, Japan
| | - Yoichi Yamamoto
- Division of Endoscopy, Shizuoka Cancer Center, Sunto-gun, Shizuoka, Japan
| | - Masao Yoshida
- Division of Endoscopy, Shizuoka Cancer Center, Sunto-gun, Shizuoka, Japan
| | - Yuki Maeda
- Division of Endoscopy, Shizuoka Cancer Center, Sunto-gun, Shizuoka, Japan
| | - Noboru Kawata
- Division of Endoscopy, Shizuoka Cancer Center, Sunto-gun, Shizuoka, Japan
| | - Junya Sato
- Division of Endoscopy, Shizuoka Cancer Center, Sunto-gun, Shizuoka, Japan
| | | | | | - Takuma Oishi
- Division of Pathology, Shizuoka Cancer Center, Sunto-gun, Shizuoka, Japan
| | - Takashi Sugino
- Division of Pathology, Shizuoka Cancer Center, Sunto-gun, Shizuoka, Japan
| | - Keita Mori
- Clinical Trial Coordination Office, Shizuoka Cancer Center, Sunto-gun, Shizuoka, Japan
| | - Hiroyuki Ono
- Division of Endoscopy, Shizuoka Cancer Center, Sunto-gun, Shizuoka, Japan
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Wehbe H, Gutta A, Gromski MA. Updates on the Prevention and Management of Post-Polypectomy Bleeding in the Colon. Gastrointest Endosc Clin N Am 2024; 34:363-381. [PMID: 38395489 DOI: 10.1016/j.giec.2023.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2024]
Abstract
Post-polypectomy bleeding (PPB) remains a significant procedure-related complication, with multiple risk factors determining the risk including patient demographics, polyp characteristics, endoscopist expertise, and techniques of polypectomy. Immediate PPB is usually treated promptly, but management of delayed PPB can be challenging. Cold snare polypectomy is the optimal technique for small sessile polyps with hot snare polypectomy for pedunculated and large sessile polyps. Topical hemostatic powders and gels are being investigated for the prevention and management of PPB. Further studies are needed to compare these topical agents with conventional therapy.
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Affiliation(s)
- Hisham Wehbe
- Department of Internal Medicine, Indiana University School of Medicine, 550 University Boulevard, UH 3533, Indianapolis, IN 46202, USA
| | - Aditya Gutta
- Department of Medicine, Division of Gastroenterology and Hepatology, Indiana University School of Medicine, 550 North University Boulevard, Suite 4100 Indianapolis, IN 46202, USA
| | - Mark A Gromski
- Department of Medicine, Division of Gastroenterology and Hepatology, Indiana University School of Medicine, 550 North University Boulevard, Suite 4100 Indianapolis, IN 46202, USA.
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Podboy A, Wang AY. Electrosurgical Principles: Beyond Blue and Yellow Pedal. Am J Gastroenterol 2024:00000434-990000000-00999. [PMID: 38275235 DOI: 10.14309/ajg.0000000000002681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 12/28/2023] [Indexed: 01/27/2024]
Affiliation(s)
- Alexander Podboy
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Virginia, Charlottesville, Virginia, USA
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Masunaga T, Kato M, Sasaki M, Iwata K, Miyazaki K, Kubosawa Y, Mizutani M, Takatori Y, Matsuura N, Nakayama A, Takabayashi K, Yahagi N. Novel quantitative assessment indicators for efficiency and precision of endoscopic submucosal dissection in animal training models by analyzing an electrical surgical unit. Dig Endosc 2024; 36:19-27. [PMID: 37405690 DOI: 10.1111/den.14632] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 07/02/2023] [Indexed: 07/06/2023]
Abstract
OBJECTIVES Although endoscopic submucosal dissection (ESD) training is important, quantitative assessments have not been established. This study aimed to explore a novel quantitative assessment system by analyzing an electrical surgical unit (ESU). METHODS This was an ex vivo study. Step one: to identify the novel efficiency indicators, 20 endoscopists performed one ESD each, and we analyzed correlations between their resection speed and electrical status. Step two: to identify the novel precision indicators, three experts and three novices performed one ESD each, and we compared the stability of the electrical status. Step three: three novices in step two performed 19 additional ESDs, and we analyzed the learning curve using novel indicators. RESULTS Step one: the percentage of total activation time (AT) of ESU in the procedure time (β coefficient, 0.80; P < 0.01) and AT required for submucosal dissection (β coefficient, -0.57; P < 0.01) were significantly correlated with the resection speed. Step two: coefficient of variation of the AT per one pulse (0.16 [range, 0.13-0.17] vs. 0.26 [range, 0.20-0.41], P = 0.049) and coefficient of variation of the peak electric power per pulse during mucosal incision (0.14 [range, 0.080-0.15] vs. 0.25 [range, 0.24-0.28], P = 0.049) were significantly lower in the experts than in the novices. Regarding the learning curve, the percentage of total AT of ESU in the procedure time and AT required for submucosal dissection had a trend of improvement. CONCLUSION Novel indicators identified by analyzing ESU enable quantitative assessment for endoscopist's skill.
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Affiliation(s)
- Teppei Masunaga
- Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo, Japan
| | - Motohiko Kato
- Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo, Japan
| | - Motoki Sasaki
- Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo, Japan
| | - Kentaro Iwata
- Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo, Japan
| | - Kurato Miyazaki
- Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo, Japan
| | - Yoko Kubosawa
- Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo, Japan
| | - Mari Mizutani
- Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo, Japan
| | - Yusaku Takatori
- Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo, Japan
| | - Noriko Matsuura
- Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo, Japan
| | - Atsushi Nakayama
- Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo, Japan
| | - Kaoru Takabayashi
- Center for Diagnostic and Therapeutic Endoscopy, Keio University School of Medicine, Tokyo, Japan
| | - Naohisa Yahagi
- Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo, Japan
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Pereira Funari M, Ottoboni Brunaldi V, Mendonça Proença I, Aniz Gomes PV, Almeida Queiroz LT, Zamban Vieira Y, Eiji Matuguma S, Ide E, Prince Franzini TA, Lera Dos Santos ME, Cheng S, Kazuyoshi Minata M, Dos Santos JS, Turiani Hourneaux de Moura D, Kemp R, Guimarães Hourneaux de Moura E. Pure Cut or Endocut for Biliary Sphincterotomy? A Multicenter Randomized Clinical Trial. Am J Gastroenterol 2023; 118:1871-1879. [PMID: 37543748 DOI: 10.14309/ajg.0000000000002458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 07/13/2023] [Indexed: 08/07/2023]
Abstract
INTRODUCTION Adverse events (AE) after endoscopic retrograde cholangiopancreatography (ERCP) are not uncommon and post-ERCP acute pancreatitis (PEP) is the most important one. Thermal injury from biliary sphincterotomy may play an important role and trigger PEP or bleeding. Therefore, this study evaluated the outcomes of 2 electric current modes used during biliary sphincterotomy. METHODS From October 2019 to August 2021, consecutive patients with native papilla undergoing ERCP with biliary sphincterotomy were randomized to either the pure cut or endocut after cannulation. The primary outcome was PEP incidence. Secondary outcomes included intraprocedural and delayed bleeding, infection, and perforation. RESULTS A total of 550 patients were randomized (272 pure cut and 278 endocut). The overall PEP rate was 4.0% and significantly higher in the endocut group (5.8% vs 2.2%, P = 0.034). Univariate analysis revealed >5 attempts ( P = 0.004) and endocut mode ( P = 0.034) as risk factors for PEP. Multivariate analysis revealed >5 attempts ( P = 0.005) and a trend for endocut mode as risk factors for PEP ( P = 0.052). Intraprocedural bleeding occurred more often with pure cut ( P = 0.018), but all cases were controlled endoscopically during the ERCP. Delayed bleeding was more frequent with endocut ( P = 0.047). There was no difference in perforation ( P = 1.0) or infection ( P = 0.4999) between the groups. DISCUSSION Endocut mode may increase thermal injury leading to higher rates of PEP and delayed bleeding, whereas pure cut is associated with increased intraprocedural bleeding without clinical repercussion. The electric current mode is not related to perforation or infection. Further RCT assessing the impact of electric current on AE with overlapping preventive measures such as rectal nonsteroidal anti-inflammatory drugs and hyperhydration are needed. The study was submitted to the Brazilian Clinical Trials Platform ( http://www.ensaiosclinicos.gov.br ) under the registry number RBR-5d27tn.
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Affiliation(s)
- Mateus Pereira Funari
- Gastrointestinal Endoscopy Unit, Gastroenterology Department, University of São Paulo Medical School, São Paulo, Brazil
| | - Vitor Ottoboni Brunaldi
- Surgery and Anatomy Department, Division of Gastrointestinal Surgery, Faculty of Medicine of Ribeirão Preto, Ribeirão Preto, Brazil
| | - Igor Mendonça Proença
- Gastrointestinal Endoscopy Unit, Gastroenterology Department, University of São Paulo Medical School, São Paulo, Brazil
| | - Pedro Victor Aniz Gomes
- Gastrointestinal Endoscopy Unit, Gastroenterology Department, University of São Paulo Medical School, São Paulo, Brazil
| | - Lucas Tobias Almeida Queiroz
- Surgery and Anatomy Department, Division of Gastrointestinal Surgery, Faculty of Medicine of Ribeirão Preto, Ribeirão Preto, Brazil
| | - Yuri Zamban Vieira
- Surgery and Anatomy Department, Division of Gastrointestinal Surgery, Faculty of Medicine of Ribeirão Preto, Ribeirão Preto, Brazil
| | - Sergio Eiji Matuguma
- Gastrointestinal Endoscopy Unit, Gastroenterology Department, University of São Paulo Medical School, São Paulo, Brazil
| | - Edson Ide
- Gastrointestinal Endoscopy Unit, Gastroenterology Department, University of São Paulo Medical School, São Paulo, Brazil
| | | | | | - Spencer Cheng
- Gastrointestinal Endoscopy Unit, Gastroenterology Department, University of São Paulo Medical School, São Paulo, Brazil
| | - Maurício Kazuyoshi Minata
- Gastrointestinal Endoscopy Unit, Gastroenterology Department, University of São Paulo Medical School, São Paulo, Brazil
| | - José Sebastião Dos Santos
- Surgery and Anatomy Department, Division of Gastrointestinal Surgery, Faculty of Medicine of Ribeirão Preto, Ribeirão Preto, Brazil
| | | | - Rafael Kemp
- Surgery and Anatomy Department, Division of Gastrointestinal Surgery, Faculty of Medicine of Ribeirão Preto, Ribeirão Preto, Brazil
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Jena A, Jain S, Sundaram S, Singh AK, Chandnani S, Rathi P. Electrosurgical unit in GI endoscopy: the proper settings for practice. Expert Rev Gastroenterol Hepatol 2023; 17:825-835. [PMID: 37497836 DOI: 10.1080/17474124.2023.2242243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 06/14/2023] [Accepted: 07/26/2023] [Indexed: 07/28/2023]
Abstract
INTRODUCTION Electrosurgical unit (ESU) is integral to the endoscopy unit. The proper knowledge of the Mode with setting is essential for good therapeutic outcomes and the safety of the patients. AREAS COVERED ESU generates high-frequency electric current, which could perform cutting and coagulation for various therapeutic interventions. We review the proper settings for common endoscopic interventions like hemostasis, polypectomy, sphincterotomy, and advanced procedures like endoscopic ultrasound-guided cysto-gastrostomy, bile duct drainage, and endoscopic Ampullectomy. We review the various waveforms of ESU in practice in endoscopy, including special conditions like patients with pacemakers. EXPERT OPINION Knowledge of the waveforms' duty cycle and crest factor is necessary. A high-duty cycle and lower crest factor lead to a good cutting effect on the tissue. Endocut is the most commonly used Mode in ESU in endoscopic practices like sphincterotomy and polypectomy. Endocut I mode (effect 1-2, duration 3, interval 3) is used for endoscopic sphincterotomy, while Forced Coag mode (Effect 2, 60 W) controls post-sphincterotomy bleeding. Endocut Q mode (Effect 2-3, duration 1, interval 3) is used for cutting the polyp, while Forced Coag mode (Effect 2, 60 W) is used before cutting for pre-coagulation of the stalk.
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Affiliation(s)
- Anuraag Jena
- Department of Gastroenterology, BYL Nair Hospital and Topiwala National Medical College, Mumbai, India
| | - Shubham Jain
- Department of Gastroenterology, BYL Nair Hospital and Topiwala National Medical College, Mumbai, India
| | - Sridhar Sundaram
- Department of Digestive Diseases and Clinical Nutrition, Tata Memorial Hospital, Mumbai, India
| | - Anupam Kumar Singh
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sanjay Chandnani
- Department of Gastroenterology, BYL Nair Hospital and Topiwala National Medical College, Mumbai, India
| | - Pravin Rathi
- Department of Gastroenterology, BYL Nair Hospital and Topiwala National Medical College, Mumbai, India
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Abu-Sbeih H, Tang T, Ali FS, Ma W, Shatila M, Luo W, Tan D, Tang C, Richards DM, Ge PS, Thomas AS, Wang Y. Clinical Features and Management of Acute and Chronic Radiation-Induced Colitis and Proctopathy. Cancers (Basel) 2023; 15:3160. [PMID: 37370770 DOI: 10.3390/cancers15123160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 06/03/2023] [Accepted: 06/09/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND RICAP is a recognized adverse effect of radiation therapy (RT) that can adversely affect cancer patients' quality of life. Data on the clinical characteristics and outcomes of RICAP are scarce. We aimed to analyze the clinical and endoscopic characteristics of acute or chronic radiation-induced colitis and proctopathy (ARICAP and CRICAP) based on symptom onset after RT (≤ or >45 days, respectively). METHODS This is a retrospective observational study of a single tertiary cancer center, from January 2010 and December 2018, of cancer patients with endoscopically confirmed ARICAP and CRICAP. We conducted univariate and multivariate logistic regression analyses to associate clinical variables with endoscopic and medical outcomes. RESULTS One hundred and twelve patients were included (84% Caucasian; 55% female; median age of 59 years); 46% had ARICAP with non-bloody diarrhea as the predominant symptom, whereas 55% had CRICAP with mostly bloody diarrhea. Neovascularization was the most frequent finding on endoscopy, followed by bleeding. ARICAP patients more often received medical management (p < 0.001), whereas CRICAP patients with bleeding more often received argon plasma coagulation (APC) (p = 0.002). Female sex and undergoing less-intense RT treatments were more associated with medical treatment; bleeding clinically and during the endoscopy was more associated with APC treatment. However, APC treatment did not significantly reduce bleeding recurrence or RICAP symptoms. CONCLUSION Patients with ARICAP and CRICAP experience different symptoms. Medical management should be considered before endoscopic therapy. APC may be useful in patients with endoscopically apparent bleeding.
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Affiliation(s)
- Hamzah Abu-Sbeih
- Department of Gastroenterology, Hepatology, and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
- Department of Internal Medicine, University of Missouri, Kansas City, MO 65211, USA
| | - Tenglong Tang
- Department of Gastroenterology, Hepatology, and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
- Department of General Surgery, The Second Xiangya Hospital of Central South University, Changsha 410011, China
| | - Faisal S Ali
- Department of Gastroenterology, Hepatology, and Nutrition, The University of Texas Health Science Center, Houston, TX 77030, USA
| | - Weijie Ma
- Department of Gastroenterology, Hepatology, and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
- Department of Hepatobiliary and Pancreatic Surgery, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
| | - Malek Shatila
- Department of Gastroenterology, Hepatology, and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Wenyi Luo
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Dongfeng Tan
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Chad Tang
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - David M Richards
- Department of Gastroenterology, Hepatology, and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Phillip S Ge
- Department of Gastroenterology, Hepatology, and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Anusha S Thomas
- Department of Gastroenterology, Hepatology, and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Yinghong Wang
- Department of Gastroenterology, Hepatology, and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
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Yu Z, He J, Cao R, Yang Z, Li B, Hong J, Chen Y, Zhu L. Proton pump inhibitor has no effect in the prevention of post-endoscopic sphincterotomy delayed bleeding: a prospective randomized controlled trial. Front Med (Lausanne) 2023; 10:1179512. [PMID: 37332745 PMCID: PMC10272718 DOI: 10.3389/fmed.2023.1179512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Accepted: 05/15/2023] [Indexed: 06/20/2023] Open
Abstract
Background and aims Bleeding is one of the common adverse events of endoscopic retrograde cholangiopancreatography (ERCP), which is mainly caused by endoscopic sphincterotomy (EST). At present, it remains unclear whether proton pump inhibitor (PPI) should be used to prevent post-EST bleeding. Therefore, we performed a randomized controlled trial to investigate whether PPI is effective in the prevention of post-EST delayed bleeding. Methods Consecutive eligible patients were randomly assigned (1:1) to experimental group (PPI group) or control group (normal saline, NS group). The patients in PPI group received intravenous esomeprazole 40 mg and normal saline 100 mL every 12 h for 2 days after ERCP immediately, and followed by oral esomeprazole (Nexium) 20 mg once a day for 7 days. Correspondingly, patients in the control group received intravenous normal saline 100 mL and did not take PPIs or any acid-suppressing drugs during hospitalization and after discharge. All patients were followed up for 30 days after ERCP. The primary endpoint was the incidence and severity of post-EST delayed bleeding. Results Between July 2020 and July 2022, 290 patients were randomly assigned to PPI group (n = 146) or NS group (n = 144). 5 patients from each group were excluded from the final analysis. There were 6 patients with post-EST delayed bleeding, with an incidence rate of 2.14%. The median time of delayed bleeding was 2.5 days after ERCP. 3 cases (2.12%, 3/141) occurred in the PPI group, with 1 case of mild and 2 cases of moderate bleeding. 3 cases (2.16%, 3/139) occurred in the NS group, with 2 cases of mild and 1 case of moderate bleeding. There was no significant difference in the incidence and the severity of post-EST delayed bleeding between the two groups (p = 1.000). Conclusion Prophylactic use of PPI after EST does not reduce the incidence and severity of post-EST delayed bleeding in patients. Clinical Trial Registration https://www.chictr.org.cn/searchproj.aspx, identifier ChiCTR2000034697.
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Gupta S, Whitfield A, Tang A, Lee EYT, Williams SJ, Burgess NG, Bourke MJ. Snare-tip soft coagulation to treat esophageal stent epithelial hyperplasia. Endoscopy 2023; 55:E572-E573. [PMID: 36958356 PMCID: PMC10036204 DOI: 10.1055/a-2050-7431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/25/2023]
Affiliation(s)
- Sunil Gupta
- Westmead Hospital, Department of Gastroenterology and Hepatology, Sydney, Australia
- University of Sydney, Westmead Clinical School, Sydney, Australia
| | - Anthony Whitfield
- Westmead Hospital, Department of Gastroenterology and Hepatology, Sydney, Australia
- University of Sydney, Westmead Clinical School, Sydney, Australia
| | - Andrew Tang
- Westmead Hospital, Department of Gastroenterology and Hepatology, Sydney, Australia
| | - Eric Y. T. Lee
- Westmead Hospital, Department of Gastroenterology and Hepatology, Sydney, Australia
| | - Stephen J. Williams
- Westmead Hospital, Department of Gastroenterology and Hepatology, Sydney, Australia
| | - Nicholas G. Burgess
- Westmead Hospital, Department of Gastroenterology and Hepatology, Sydney, Australia
- University of Sydney, Westmead Clinical School, Sydney, Australia
| | - Michael J. Bourke
- Westmead Hospital, Department of Gastroenterology and Hepatology, Sydney, Australia
- University of Sydney, Westmead Clinical School, Sydney, Australia
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Chen S, Zhou D, Yu J, Ruan R, Liu Y, Li Y, Shen Q, Wang S. A Novelly Developed Bipolar Needle Knife Can Be an Alternative Device Choice for Endoscopic Submucosal Dissection (With Video). Front Med (Lausanne) 2022; 9:888635. [PMID: 35646964 PMCID: PMC9136242 DOI: 10.3389/fmed.2022.888635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 04/11/2022] [Indexed: 11/28/2022] Open
Abstract
Background Endoscopic submucosal dissection (ESD) is technically difficult with high rates of complications, such as perforation and bleeding. We aimed to explore the safety and cutting efficiency of a novelly devised bipolar knife for ESD procedure. Methods Taking a traditional monopolar knife as a reference, the safety and feasibility of the novel bipolar knife were evaluated by an animal experiment and a human study. Furthermore, we assessed the usefulness and advantage of this novel bipolar knife by using the finite element method. Results A porcine experiment confirmed that there was no significant difference in wound size and cutting speed between the monopolar and bipolar knives. The thermal damage and histopathological scores produced by the two knives were similar. In addition, the porcine experiment and patients' study identified that the incidence of postoperative complications, such as bleeding, perforation, and infection, had no statistical difference between the monopolar and bipolar groups. Finally, the finite element model showed that the length and depth of thermal damage caused by the bipolar knife were, respectively, 102.77–117.98% and 80.87–84.53% of those caused by the monopolar knife at the same power. Conclusion The novel bipolar knife was theoretically safer than the monopolar knife and, at least, was confirmed not inferior to the monopolar knife in operability and cutting efficiency. Thus, the novel bipolar knife can be an alternative device choice for ESD.
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Whitfield AM, Burgess NG, Bahin FF, Kabir S, Pellisé M, Sonson R, Subramanian V, Mahajan H, McLeod D, Byth K, Bourke MJ. Histopathological effects of electrosurgical interventions in an in vivo porcine model of colonic endoscopic mucosal resection. Gut 2022; 71:864-870. [PMID: 34172512 DOI: 10.1136/gutjnl-2021-324140] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 06/16/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Endoscopic mucosal resection (EMR) in the colon has been widely adopted, but there is limited data on the histopathological effects of the differing electrosurgical currents (ESCs) used. We used an in vivo porcine model to compare the tissue effects of ESCs for snare resection and adjuvant margin ablation techniques. DESIGN Standardised EMR was performed by a single endoscopist in 12 pigs. Two intersecting 15 mm snare resections were performed. Resections were randomised 1:1 using either a microprocessor-controlled current (MCC) or low-power coagulating current (LPCC). The lateral margins of each defect were treated with either argon plasma coagulation (APC) or snare tip soft coagulation (STSC). Colons were surgically removed at 72 hours. Two specialist pathologists blinded to the intervention assessed the specimens. RESULTS 88 defects were analysed (median 7 per pig, median defect size 29×17 mm). For snare ESC effects, 156 tissue sections were assessed. LPCC was comparable to MCC for deep involvement of the colon wall. For margin ablation, 172 tissue sections were assessed. APC was comparable to STSC for deep involvement of the colon wall. Islands of preserved mucosa at the coagulated margin were more likely with APC compared with STSC (16% vs 5%, p=0.010). CONCLUSION For snare resection, MCC and LPCC did not produce significantly different tissue effects. The submucosal injectate may protect the underlying tissue, and technique may more strongly dictate the depth and extent of final injury. For margin ablation, APC was less uniform and complete compared with STSC.
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Affiliation(s)
- Anthony M Whitfield
- Westmead Clinical School, The University of Sydney, Sydney, New South Wales, Australia.,Department of Gastroenterology and Hepatology, Westmead Hospital, Westmead, New South Wales, Australia
| | - Nicholas G Burgess
- Westmead Clinical School, The University of Sydney, Sydney, New South Wales, Australia.,Department of Gastroenterology and Hepatology, Westmead Hospital, Westmead, New South Wales, Australia
| | - Farzan F Bahin
- Westmead Clinical School, The University of Sydney, Sydney, New South Wales, Australia.,Department of Gastroenterology and Hepatology, Westmead Hospital, Westmead, New South Wales, Australia
| | - Sharir Kabir
- Department of General Surgery, Westmead Hospital, Westmead, New South Wales, Australia
| | - María Pellisé
- Gastroenterology Department, Hospital Clínic de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | - Rebecca Sonson
- Department of Gastroenterology and Hepatology, Westmead Hospital, Westmead, New South Wales, Australia
| | - Vishnu Subramanian
- Department of General Surgery, Westmead Hospital, Westmead, New South Wales, Australia
| | - Hema Mahajan
- Institute of Clinical Pathology and Medical Research, Westmead Hospital, Westmead, New South Wales, Australia
| | - Duncan McLeod
- Institute of Clinical Pathology and Medical Research, Westmead Hospital, Westmead, New South Wales, Australia
| | - Karen Byth
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, New South Wales, Australia.,WSLHD Research and Education Network, Westmead Hospital, Westmead, New South Wales, Australia
| | - Michael J Bourke
- Westmead Clinical School, The University of Sydney, Sydney, New South Wales, Australia .,Department of Gastroenterology and Hepatology, Westmead Hospital, Westmead, New South Wales, Australia
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Castillo-Regalado E, Uchima H. Endoscopic management of difficult laterally spreading tumors in colorectum. World J Gastrointest Endosc 2022; 14:113-128. [PMID: 35432746 PMCID: PMC8984535 DOI: 10.4253/wjge.v14.i3.113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 11/01/2021] [Accepted: 02/16/2022] [Indexed: 02/06/2023] Open
Abstract
Due to the advent of the screening programs for colorectal cancer and the era of quality assurance colonoscopy the number the polyps that can be considered difficult, including large (> 20 mm) laterally spreading tumors (LSTs), has increased in the last decade. All LSTs should be assessed carefully, looking for suspicious areas of submucosal invasion (SMI), such as nodules or depressed areas, describing the morphology according to the Paris classification, the pit pattern, and vascular pattern. The simplest, most appropriate and safest endoscopic treatment with curative intent should be selected. For LST-granular homogeneous type, piecemeal endoscopic mucosal resection should be the first option due to its biological low risk of SMI. LST-nongranular pseudodepressed type has an increased risk of SMI, and en bloc resection should be mandatory. Underwater endoscopic mucosal resection is useful in situations where submucosal injection alters the operative field, e.g., for the resection of scar lesions, with no lifting, adjacent tattoo, incomplete resection attempts, lesions into a colonic diverticulum, in ileocecal valve and lesions with intra-appendicular involvement. Endoscopic full thickness resection is very useful for the treatment of difficult to resect lesions of less than 20 up to 25 mm. Among the indications, we highlight the treatment of polyps with suspected malignancy because the acquired tissue allows an exact histologic risk stratification to assign patients individually to the best treatment and avoid surgery for low-risk lesions. Endoscopic submucosal dissection is the only endoscopic procedure that allows completes en bloc resection regardless of the size of the lesion. It should therefore be indicated in the treatment of lesions with risk of SMI.
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Affiliation(s)
- Edgar Castillo-Regalado
- Endoscopy Unit, Department of Gastroenterology, Hospital Universitari Germans Trias i Pujol, Barcelona 08916, Spain
- Endoscopic Unit, Creu Groga Medical Center, Calella 08370, Spain
| | - Hugo Uchima
- Endoscopy Unit, Department of Gastroenterology, Hospital Universitari Germans Trias i Pujol, Barcelona 08916, Spain
- Endoscopic Unit, Teknon Medical Center, Barcelona 08022, Spain
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Bazerbachi F, White RM, Forbes N, Goudra B, Abu Dayyeh BK, Chandrasekhara V, Sweitzer B. Endo-anesthesia: a primer. Gastroenterol Rep (Oxf) 2022; 10:goac069. [PMID: 36381224 PMCID: PMC9664071 DOI: 10.1093/gastro/goac069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Accepted: 08/31/2022] [Indexed: 11/16/2022] Open
Abstract
Gastrointestinal (GI) endoscopy has witnessed a Cambrian explosion of techniques, indications, and expanding target populations. GI endoscopy encompasses traditional domains that include preventive measures, palliation, as alternative therapies in patients with prohibitive risks of more invasive procedures, and indicated primary treatments. But, it has expanded to include therapeutic and diagnostic interventional endosonography, luminal endoscopic resection, third space endotherapy, endohepatology, and endobariatrics. The lines between surgery and endoscopy are blurred on many occasions within this paradigm. Moreover, patients with high degrees of co-morbidity and complex physiology require more nuanced peri-endoscopic management. The rising demand for endoscopy services has resulted in the development of endoscopy referral centers that offer these invasive procedures as directly booked referrals for regional and rural patients. This further necessitates specialized programs to ensure appropriate evaluation, risk stratification, and optimization for safe sedation and general anesthesia if needed. This landscape is conducive to the organic evolution of endo-anesthesia to meet the needs of these focused and evolving practices. In this primer, we delineate important aspects of endo-anesthesia care and provide relevant clinical and logistical considerations pertaining to the breadth of procedures.
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Affiliation(s)
- Fateh Bazerbachi
- CentraCare, Interventional Endoscopy Program, St. Cloud Hospital , St Cloud, MN, USA
| | - Rodger M White
- Department of Anesthesia, Massachusetts General Hospital , Boston, MA, USA
| | - Nauzer Forbes
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Calgary , Calgary, Alberta, Canada
| | - Basavana Goudra
- Department of Anesthesiology and Critical Care Medicine, Hospital of the University of Pennsylvania , Philadelphia, PA, USA
| | - Barham K Abu Dayyeh
- Division of Gastroenterology and Hepatology, Mayo Clinic , Rochester, MN, USA
| | | | - BobbieJean Sweitzer
- Systems Director, University of Virginia, Preoperative Medicine, InovaHealth , Falls Church, VA, USA
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Peng M, Guo X, Yi F, Shao X, Wang L, Wu Y, Wang C, Zhu M, Bian O, Ibrahim M, Chawla S, Qi X. Endoscopic treatment for gastric antral vascular ectasia. Ther Adv Chronic Dis 2021; 12:20406223211039696. [PMID: 34408826 PMCID: PMC8366108 DOI: 10.1177/20406223211039696] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 07/22/2021] [Indexed: 02/05/2023] Open
Abstract
Gastric antral vascular ectasia (GAVE) is one of the uncommon causes of upper gastrointestinal bleeding. Major treatment of GAVE includes pharmacotherapy, endoscopy, and surgery. The efficacy and safety of pharmacotherapy have not been sufficiently confirmed; and surgery is just considered when conservative treatment is ineffective. By comparison, endoscopy is a common treatment option for GAVE. This paper reviews the currently used endoscopic approaches for GAVE, mainly including argon plasma coagulation (APC), radiofrequency ablation (RFA), and endoscopic band ligation (EBL). It also summarizes their efficacy and procedure-related adverse events. The endoscopic success rate of APC is 40-100%; however, APC needs several treatment sessions, with a high recurrence rate of 10-78.9%. The endoscopic success rates of RFA and EBL are 90-100% and 77.8-100%, respectively; and their recurrence rates are 21.4-33.3% and 8.3-48.1%, respectively. Hyperplastic gastric polyps and sepsis are major adverse events of APC and RFA; and Mallory-Weiss syndrome is occasionally observed after APC. Adverse events of EBL are rare and mild, such as nausea, vomiting, esophageal or abdominal pain, and hyperplastic polyps. APC is often considered as the first-line choice of endoscopic treatment for GAVE. RFA and EBL have been increasingly used as alternatives in patients with refractory GAVE. A high recurrence of GAVE after endoscopic treatment should be fully recognized and cautiously managed by follow-up endoscopy. In future, a head-to-head comparison of different endoscopic approaches for GAVE is warranted.
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Affiliation(s)
- Mengyuan Peng
- Department of Gastroenterology, General Hospital of Northern Theater Command (formerly General Hospital of Shenyang Military Area), Shenyang, P.R. China
- Postgraduate College, Jinzhou Medical University, Jinzhou, P.R. China
| | - Xiaozhong Guo
- Department of Gastroenterology, General Hospital of Northern Theater Command (formerly General Hospital of Shenyang Military Area), Shenyang, P.R. China
| | - Fangfang Yi
- Department of Gastroenterology, General Hospital of Northern Theater Command (formerly General Hospital of Shenyang Military Area), Shenyang, P.R. China
| | - Xiaodong Shao
- Department of Gastroenterology, General Hospital of Northern Theater Command (formerly General Hospital of Shenyang Military Area), Shenyang, P.R. China
| | - Le Wang
- Department of Gastroenterology, General Hospital of Northern Theater Command (formerly General Hospital of Shenyang Military Area), Shenyang, P.R. China
| | - Yanyan Wu
- Department of Gastroenterology, General Hospital of Northern Theater Command (formerly General Hospital of Shenyang Military Area), Shenyang, P.R. China
| | - Chunmei Wang
- Department of Gastroenterology, General Hospital of Northern Theater Command (formerly General Hospital of Shenyang Military Area), Shenyang, P.R. China
| | - Menghua Zhu
- Department of Gastroenterology, General Hospital of Northern Theater Command (formerly General Hospital of Shenyang Military Area), Shenyang, P.R. China
| | - Ou Bian
- Department of No.1 Cadre Ward, General Hospital of Northern Theater Command (formerly General Hospital of Shenyang Military Area), Shenyang, P.R. China
| | - Mostafa Ibrahim
- Department of Gastroenterology and Hepatology, Theodor Bilharz Research Institute, Cairo, Egypt
| | - Saurabh Chawla
- Department of Medicine, Division of Digestive Diseases, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Xingshun Qi
- Department of Gastroenterology, General Hospital of Northern Theater Command (formerly General Hospital of Shenyang Military Area), No. 83 Wenhua Road, Shenyang, Liaoning Province 110840, China
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Ayala I, Cabot A, Garcia-Martinez JD, Escobar MT, Alberca F. Endoscopic Endocautery Polypectomy for the Treatment of Duodenal and Gastric Polyps in a Cat. Top Companion Anim Med 2021; 44:100537. [PMID: 33957307 DOI: 10.1016/j.tcam.2021.100537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 03/23/2021] [Accepted: 04/20/2021] [Indexed: 10/21/2022]
Abstract
Endoscopic polypectomy is commonly performed in human medicine, with large-scale studies reported. However, few reports have described its use in veterinary medicine and, specifically, the procedure in the case of duodenal polyps in cats has not been reported. A 7 kg 14-year-old cat presented with recurrent vomiting for several months. Gastroduodenoscopy revealed a pedunculated polyp at the pyloric antrum and another in the duodenum, with its head protruding into the pylorus. Endoscopic polypectomy was performed using an electrosurgical snare with no recurrence of clinical signs after six months. Duodenal polypectomy in cats may be difficult because of space limitation but it can be safe, minimally invasive, and successful, thus avoiding more invasive surgical techniques. Endoscopic polypectomy may be a viable alternative to surgery in cats with gastric and duodenal polyps.
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Affiliation(s)
- Ignacio Ayala
- University of Murcia: Universidad de Murcia, Espinardo, Murcia, Spain.
| | - Antonio Cabot
- University of Murcia: Universidad de Murcia, Espinardo, Murcia, Spain
| | | | | | - Fernando Alberca
- University of Murcia: Universidad de Murcia, Espinardo, Murcia, Spain
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KARAOĞULLARINDAN Ü. Tek Endoskopist Deneyimi; ERCP Sonuçları, Komplikasyonlar ve İlgili Faktörler. MUSTAFA KEMAL ÜNIVERSITESI TIP DERGISI 2021. [DOI: 10.17944/mkutfd.810551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Chen S, Zhou D, Ruan R, Yu J, Li Y, Liu Y, Wang S. A Novel Bipolar Polypectomy Snare Can Be an Alternative Choice for Endoscopic Resection. Front Med (Lausanne) 2021; 7:619844. [PMID: 33553214 PMCID: PMC7855578 DOI: 10.3389/fmed.2020.619844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 12/15/2020] [Indexed: 12/24/2022] Open
Abstract
Objective: Endoscopic resection (ER) is more difficult and has a higher rate of complications, such as perforation and bleeding. The aim of this study was to evaluate the safety and feasibility of a bipolar polypectomy snare for ER. Methods: Initial ER procedures in live pigs were carried out. Then, a human feasibility study was performed in patients with colorectal polyps. Finally, the finite element method was used to evaluate the safety and effectiveness of the new bipolar snare. Results: In the live animal model, there were no significant differences in wound size and cutting time between monopolar and bipolar groups. The histological results (histological scores) of the two groups in porcine experiments were almost the same except that the incision flatness of bipolar group was better than that of the monopolar group. Incidence of bleeding and perforation was similar between the two groups in pigs' and patients' study. At last, the finite element model showed that the vertical thermal damage depth produced by bipolar snare system was approximately 71–76% of that produced by monopolar snare system at the same power. Conclusions: The novel bipolar snare is feasible in patients with colorectal polyps and can be an alternative choice for ERs.
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Affiliation(s)
- Shengsen Chen
- Department of Endoscopy, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Cancer and Basic Medicine (IBMC), Chinese Academy of Sciences, Hangzhou, Zhejiang, China
| | - Danping Zhou
- Department of Endoscopy, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Cancer and Basic Medicine (IBMC), Chinese Academy of Sciences, Hangzhou, Zhejiang, China
| | - Rongwei Ruan
- Department of Endoscopy, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Cancer and Basic Medicine (IBMC), Chinese Academy of Sciences, Hangzhou, Zhejiang, China
| | - Jiangping Yu
- Department of Endoscopy, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Cancer and Basic Medicine (IBMC), Chinese Academy of Sciences, Hangzhou, Zhejiang, China
| | - Yandong Li
- Department of Endoscopy, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Cancer and Basic Medicine (IBMC), Chinese Academy of Sciences, Hangzhou, Zhejiang, China
| | - Yuanshun Liu
- Department of Endoscopy, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Cancer and Basic Medicine (IBMC), Chinese Academy of Sciences, Hangzhou, Zhejiang, China
| | - Shi Wang
- Department of Endoscopy, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Cancer and Basic Medicine (IBMC), Chinese Academy of Sciences, Hangzhou, Zhejiang, China
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Funari MP, Ribeiro IB, de Moura DTH, Bernardo WM, Brunaldi VO, Rezende DT, Resende RH, de Marco MO, Franzini TAP, de Moura EGH. Adverse events after biliary sphincterotomy: Does the electric current mode make a difference? A systematic review and meta-analysis of randomized controlled trials. Clin Res Hepatol Gastroenterol 2020; 44:739-752. [PMID: 32088149 DOI: 10.1016/j.clinre.2019.12.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 11/24/2019] [Accepted: 12/18/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND Biliary sphincterotomy is an invasive method that allows access to the bile ducts, however, this procedure is not exempt of complications. Studies in the literature indicate that the mode of electric current used for sphincterotomy may carry different incidences of adverse events such as pancreatitis, hemorrhage, perforation, and cholangitis. AIM To evaluate the safety of different modes of electrical current during biliary sphincterotomy based on incidence of adverse events. METHODS We searched articles for this systematic review in Medline, EMBASE, Central Cochrane, Lilacs, and gray literature from inception to September 2019. Data from studies describing different types of electric current were meta-analyzed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The following electric current modalities were evaluated: endocut, blend, pure cut, pure cut followed by blend, monopolar, and bipolar. RESULTS A total of 1791 patients from 11 randomized clinical trials evaluating the following comparisons: 1. Endocut vs Blend: No statistical difference in the incidence of bleeding (7% vs 13.4%; RD: -0.11 [-0.31, 0.08], P=0.27, I2=86%), pancreatitis (4.4% vs 3.5%; RD: 0.01 [-0.03, 0.04], P=0.62, I2=48%) and perforation (absence of cases in both arms). 2. Endocut vs Pure cut: Higher incidence of mild bleeding (without drop in hemoglobin levels, clinical repercussion or need for endoscopic intervention) in the pure cut group (9.2% vs 28.8%; RD: -0.19 [-0.27, -0.12], P<0.00001, I2=0%). No statistical difference regarding pancreatitis (5.2% vs 0.9%; RD: 0.05 [-0.01, 0.11], P=0.12, I2=57%), perforation (0.4% vs 0%; RD: 0.00 [-0.01, 0.02], P=0.7, I2=0%) or cholangitis (1.8% vs 3.2%; RD: -0.01 [-0.09, 0.06], P=0,7). 3. Pure cut vs blend: higher incidence of mild bleeding in the pure cut group (40.4% vs 16.7%; RD: 0.24 [0.15, 0.33], P<0.00001, I2=0%). No statistical difference concerning incidence of pancreatitis or cholangitis. 4. Pure cut vs Pure cut followed by Blend: No statistical difference regarding incidence of bleeding (22.5% vs 11.7%; RD: -0.10 [-0.24, 0.04], P=0.18, I2=61%) and pancreatitis (8.9% vs 14.8%; RD 0.06 [-0.02, 0.13], P=0.12, I2=0%). 5. Blend vs pure cut followed by blend: no statistical difference regarding incidence of bleeding and pancreatitis (11.3% vs 10.4%; RD -0.01 [-0.11, 0.09], P=0.82, I2=0%). 6. Monopolar vs bipolar: higher incidence of pancreatitis in the monopolar mode group (12% vs 0%; RD 0.12 [0.02, 0.22], P=0.01). CONCLUSION Pure cut carries higher incidences of mild bleeding compared to endocut and blend. However, this modality might present a lower incidence of pancreatitis. The monopolar mode elicits higher rates of pancreatitis in comparison with the bipolar mode. There is no difference in incidence of cholangitis or perforation between different types of electric current. There is a lack of evidence in the literature to recommend one method over the others, therefore new studies are warranted. As there is no perfect electric current mode, the choice in clinical practice must be based on the patient risk factors.
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Affiliation(s)
- Mateus Pereira Funari
- Gastrointestinal Endoscopy Unit, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo - HC/FMUSP, Instituto Central, Prédio dos Ambulatórios, Av. Dr. Enéas de Carvalho Aguiar 255, Pinheiros, São Paulo, Brazil
| | - Igor Braga Ribeiro
- Gastrointestinal Endoscopy Unit, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo - HC/FMUSP, Instituto Central, Prédio dos Ambulatórios, Av. Dr. Enéas de Carvalho Aguiar 255, Pinheiros, São Paulo, Brazil.
| | - Diogo Turiani Hourneaux de Moura
- Gastrointestinal Endoscopy Unit, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo - HC/FMUSP, Instituto Central, Prédio dos Ambulatórios, Av. Dr. Enéas de Carvalho Aguiar 255, Pinheiros, São Paulo, Brazil; Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Wanderley Marques Bernardo
- Gastrointestinal Endoscopy Unit, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo - HC/FMUSP, Instituto Central, Prédio dos Ambulatórios, Av. Dr. Enéas de Carvalho Aguiar 255, Pinheiros, São Paulo, Brazil
| | - Vitor Ottoboni Brunaldi
- Gastrointestinal Endoscopy Unit, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo - HC/FMUSP, Instituto Central, Prédio dos Ambulatórios, Av. Dr. Enéas de Carvalho Aguiar 255, Pinheiros, São Paulo, Brazil
| | - Daniel Tavares Rezende
- Gastrointestinal Endoscopy Unit, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo - HC/FMUSP, Instituto Central, Prédio dos Ambulatórios, Av. Dr. Enéas de Carvalho Aguiar 255, Pinheiros, São Paulo, Brazil
| | - Ricardo Hannum Resende
- Gastrointestinal Endoscopy Unit, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo - HC/FMUSP, Instituto Central, Prédio dos Ambulatórios, Av. Dr. Enéas de Carvalho Aguiar 255, Pinheiros, São Paulo, Brazil
| | - Michele Oliveira de Marco
- Gastrointestinal Endoscopy Unit, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo - HC/FMUSP, Instituto Central, Prédio dos Ambulatórios, Av. Dr. Enéas de Carvalho Aguiar 255, Pinheiros, São Paulo, Brazil
| | - Tomazo Antonio Prince Franzini
- Gastrointestinal Endoscopy Unit, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo - HC/FMUSP, Instituto Central, Prédio dos Ambulatórios, Av. Dr. Enéas de Carvalho Aguiar 255, Pinheiros, São Paulo, Brazil
| | - Eduardo Guimarães Hourneaux de Moura
- Gastrointestinal Endoscopy Unit, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo - HC/FMUSP, Instituto Central, Prédio dos Ambulatórios, Av. Dr. Enéas de Carvalho Aguiar 255, Pinheiros, São Paulo, Brazil
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Samuels JM, Overbey DM, Wikiel KJ, Jones TS, Robinson TN, Jones EL. Electromagnetic interference on cardiac pacemakers and implantable cardioverter defibrillators during endoscopy as reported to the US Federal Drug Administration. Surg Endosc 2020; 35:3796-3801. [PMID: 32804270 DOI: 10.1007/s00464-020-07872-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 08/05/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION More than 3 million patients have a cardiac implanted electronic device (CIED) such as a pacemaker or implanted cardioverter-defibrillator in the USA. These devices are susceptible to electromagnetic interference (EMI) leading to malfunction and injury. Radiofrequency energy, the most common modality for obtaining hemostasis during endoscopy, is the most common source of EMI. Few studies have evaluated the effect of endoscopic radiofrequency energy on CIEDs. We aim to characterize CIED dysfunction related to endoscopic procedures. We hypothesize that EMI from endoscopic energy can result in patient injury. METHODS We queried the Manufacturer and User Facility Device Experience (MAUDE) database for CIED dysfunction related to electrosurgical devices over a 10-year period (2009-2019). CIED dysfunction events were identified using seven problem codes (malfunction, electromagnetic interference, ambient noise, pacing problem, over-sensing, inappropriate shock, defibrillation). These were cross-referenced for the terms "cautery, electrocautery, endoscopy, esophagus, colonoscopy, colon, esophagoscopy, and esophagogastroduodenoscopy." Reports were individually reviewed to confirm and characterize CIED malfunction due to an endoscopic procedure. RESULTS A search for CIED dysfunction resulted in 43,759 reports. Three hundred and eleven reports (0.7%) were associated with electrocautery, and of these, 45 reports (14.5%) included endoscopy. Ten reports involving endoscopy (22%) specified upper (3, 7%) or lower (7, 16%) endoscopy while the remainder were non-specific. Twenty-six of reports involving endoscopy (58%) suffered injury because of CIED dysfunction: Of these, 17 (65%) received inappropriate shocks, 5 (19%) had pacing inhibition with bradycardia or asystole, 3 (12%) had CIED damage requiring explant and replacement, and 1 (4%) patient suffered ventricular tachycardia requiring hospital admission. CONCLUSION The use of energy during endoscopy can cause dysfunction of CIEDs. This most commonly results in inappropriate defibrillation, symptomatic bradycardia, and asystole. Patients with CIEDs undergoing endoscopy should undergo pre- and post-procedure device interrogation and re-programming to avoid patient injury.
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Affiliation(s)
- Jason M Samuels
- Department of Surgery, University of Colorado, Aurora, CO, USA
| | | | - Krzysztof J Wikiel
- Rocky Mountain Regional Veterans Affairs Medical Center, University of Colorado, 1700 North Wheeling St, Mail Stop 112, Aurora, CO, 80045, USA
| | - Teresa S Jones
- Rocky Mountain Regional Veterans Affairs Medical Center, University of Colorado, 1700 North Wheeling St, Mail Stop 112, Aurora, CO, 80045, USA
| | - Thomas N Robinson
- Rocky Mountain Regional Veterans Affairs Medical Center, University of Colorado, 1700 North Wheeling St, Mail Stop 112, Aurora, CO, 80045, USA
| | - Edward L Jones
- Rocky Mountain Regional Veterans Affairs Medical Center, University of Colorado, 1700 North Wheeling St, Mail Stop 112, Aurora, CO, 80045, USA.
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21
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Pohl H, Grimm IS, Moyer MT, Hasan MK, Pleskow D, Elmunzer BJ, Khashab MA, Sanaei O, Al-Kawas FH, Gordon SR, Mathew A, Levenick JM, Aslanian HR, Antaki F, von Renteln D, Crockett SD, Rastogi A, Gill JA, Law RJ, Elias PA, Pellise M, Mackenzie TA, Rex DK. Effects of Blended (Yellow) vs Forced Coagulation (Blue) Currents on Adverse Events, Complete Resection, or Polyp Recurrence After Polypectomy in a Large Randomized Trial. Gastroenterology 2020; 159:119-128.e2. [PMID: 32173478 PMCID: PMC8262363 DOI: 10.1053/j.gastro.2020.03.014] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 02/19/2020] [Accepted: 03/09/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS There is debate over the type of electrosurgical setting that should be used for polyp resection. Some endoscopists use a type of blended current (yellow), whereas others prefer coagulation (blue). We performed a single-blinded, randomized trial to determine whether type of electrosurgical setting affects risk of adverse events or recurrence. METHODS Patients undergoing endoscopic mucosal resection of nonpedunculated colorectal polyps 20 mm or larger (n = 928) were randomly assigned, in a 2 × 2 design, to groups that received clip closure or no clip closure of the resection defect (primary intervention) and then to either a blended current (Endocut Q) or coagulation current (forced coagulation) (Erbe Inc) (secondary intervention and focus of the study). The study was performed at multiple centers, from April 2013 through October 2017. Patients were evaluated 30 days after the procedure (n = 919), and 675 patients underwent a surveillance colonoscopy at a median of 6 months after the procedure. The primary outcome was any severe adverse event in a per patient analysis. Secondary outcomes were complete resection and recurrence at first surveillance colonoscopy in a per polyp analysis. RESULTS Serious adverse events occurred in 7.2% of patients in the Endocut group and 7.9% of patients in the forced coagulation group, with no significant differences in the occurrence of types of events. There were no significant differences between groups in proportions of polyps that were completely removed (96% in the Endocut group vs 95% in the forced coagulation group) or the proportion of polyps found to have recurred at surveillance colonoscopy (17% and 17%, respectively). Procedural characteristics were comparable, except that 17% of patients in the Endocut group had immediate bleeding that required an intervention, compared with 11% in the forced coagulation group (P = .006). CONCLUSIONS In a randomized trial to compare 2 commonly used electrosurgical settings for the resection of large colorectal polyps (Endocut vs forced coagulation), we found no difference in risk of serious adverse events, complete resection rate, or polyp recurrence. Electrosurgical settings can therefore be selected based on endoscopist expertise and preference. Clinicaltrials.gov ID NCT01936948.
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Affiliation(s)
- Heiko Pohl
- Dartmouth Geisel School of Medicine, Hanover, New Hampshire; Section of Gastroenterology and Hepatology, Veterans Affairs Medical Center White River Junction, Vermont.
| | - Ian S. Grimm
- Division of Gastroenterology and Hepatology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Matthew T. Moyer
- Matthew T. Moyer, Division of Gastroenterology and Hepatology, Penn State Hershey Medical Center, Hershey, Pennsylvania
| | - Muhammad K. Hasan
- Muhammad K. Hasan, Center for Interventional Endoscopy, Florida Hospital, Orlando, Florida
| | - Douglas Pleskow
- Douglas Pleskow, Division of Gastroenterology Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - B. Joseph Elmunzer
- Division of Gastroenterology and Hepatology, Medical University of South Carolina, Charleston, South Carolina
| | - Mouen A. Khashab
- Mouen A. Khashab, Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland
| | - Omid Sanaei
- Mouen A. Khashab, Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland
| | - Firas H. Al-Kawas
- Mouen A. Khashab, Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland,Sibley Memorial Hospital, Washington, DC
| | - Stuart R. Gordon
- Dartmouth Geisel School of Medicine, Hanover, New Hampshire,Department of Gastroenterology and Hepatology, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire
| | - Abraham Mathew
- Matthew T. Moyer, Division of Gastroenterology and Hepatology, Penn State Hershey Medical Center, Hershey, Pennsylvania
| | - John M. Levenick
- Matthew T. Moyer, Division of Gastroenterology and Hepatology, Penn State Hershey Medical Center, Hershey, Pennsylvania
| | - Harry R. Aslanian
- Section of Digestive Diseases, Yale-New Haven Hospital, New Haven, Connecticut
| | - Fadi Antaki
- Division of Gastroenterology, John D. Dingell Veterans Affairs Medical Center and Wayne State University, Detroit, Michigan
| | - Daniel von Renteln
- Division of Gastroenterology, University of Montreal Medical Center and Research Center, Montreal, Quebec, Canada
| | - Seth D. Crockett
- Division of Gastroenterology and Hepatology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Amit Rastogi
- Division of Gastroenterology, Hepatology and Motility, University of Kansas Medical Center, Kansas City, Kansas
| | - Jeffrey A. Gill
- Division of Gastroenterology James A. Haley Veterans Affairs Medical Center, University of South Florida, Tampa, Florida
| | - Ryan J. Law
- Division of Gastroenterology and Hepatology University of Michigan, Ann Arbor, Michigan
| | - Pooja A. Elias
- Division of Gastroenterology and Hepatology, Medical University of South Carolina, Charleston, South Carolina
| | - Maria Pellise
- Gastroenterology Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Todd A. Mackenzie
- The Dartmouth Institute, Department for Biomedical Data Science, Lebanon, New Hampshire
| | - Douglas K. Rex
- Indiana University School of Medicine, Indianapolis, Indiana
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22
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Endoscopic Retrograde Cholangiopancreatography-Related Complications and Their Management Strategies: A "Scoping" Literature Review. Dig Dis Sci 2020; 65:361-375. [PMID: 31792671 DOI: 10.1007/s10620-019-05970-3] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 11/16/2019] [Indexed: 12/12/2022]
Abstract
Endoscopic retrograde cholangiopancreatography (ERCP) is a well-known procedure with both diagnostic and therapeutic utilities in managing pancreaticobiliary conditions. With the advancements of endoscopic techniques, ERCP has become a relatively safe and effective procedure. However, as ERCP is increasingly being utilized for different advanced techniques, newer complications have been noticed. Post-ERCP complications are known, and mostly include pancreatitis, infection, hemorrhage, and perforation. The risks of these complications vary depending on several factors, such as patient selection, endoscopist's skills, and the difficulties involved during the procedure. This review discusses post-ERCP complications and management strategies with new and evolving concepts.
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23
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Li DF, Yang MF, Chang X, Wang NN, Tan FF, Xie HN, Fang X, Wang SL, Fan W, Wang JY, Yu ZC, Wei C, Xiong F, Liu TT, Luo MH, Wang LS, Li ZS, Yao J, Bai Y. Endocut Versus Conventional Blended Electrosurgical Current for Endoscopic Biliary Sphincterotomy: A Meta-Analysis of Complications. Dig Dis Sci 2019; 64:2088-2094. [PMID: 30778871 DOI: 10.1007/s10620-019-05513-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Accepted: 02/01/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND AIMS Endoscopic biliary sphincterotomy (EST) is commonly performed during therapeutic endoscopic retrograde cholangiopancreatography (ERCP), but is an independent risk factor for post-ERCP pancreatitis, bleeding and duodenal perforation. These are partly ascribed to the electrosurgical current mode used for EST, and currently the optimal current model for EST remains controversial. In this study, we aimed to compare the rate of complications undergoing EST using the Endocut versus the blended current. METHODS A systematic search of databases was performed for relevant published and prospective studies including randomized clinical trials (RCTs) to compare Endocut with blended current modes for EST. Data were collected from inception until 1 July 2018, using post-ERCP pancreatitis, bleeding and perforation as primary outcomes. RESULTS Three RCTs including a total of 594 patients met the inclusion criteria. Our meta-analysis results showed the rate of post-ERCP pancreatitis, primarily mild to moderate pancreatitis, was no different between Endocut versus blended current modes [risk ratio (RR) 0.61, 95% confidence interval (CI) 0.25-1.52, P = 0.29]. However, the risk of endoscopically bleeding events, primarily mild bleeding, was lower in studies using Endocut versus blended current (RR 0.54, 95% CI 0.31-0.95, P = 0.03). Notably, none of the patients experienced perforation in these three trials. CONCLUSIONS The rate of post-ERCP pancreatitis was not significantly different when using the Endocut versus blended current during EST. Nevertheless, compared with the blended current, Endocut reduced the incidence of endoscopically evident bleeding; however, the available data were insufficient to assess the perforation risk.
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Affiliation(s)
- De-Feng Li
- Department of Gastroenterology, The 2nd Clinical Medicine College (Shenzhen People's Hospital) of Jinan University, Shenzhen, 518020, China.,Integrated Chinese and Western Medicine Postdoctoral Research Station, Jinan University, Guangzhou, 510632, China.,Department of Gastroenterology, The First Affiliated Hospital of University of South China, University of South China, Hengyang, 421001, China
| | - Mei-Feng Yang
- Department of Hematology, The First Affiliated Hospital of University of South China, University of South China, Hengyang, 421001, China
| | - Xin Chang
- Department of Gastroenterology, Changhai Hospital, Second Military Medical University, Yangpu District, Shanghai, 200433, China
| | - Nan-Nan Wang
- Department of Gastroenterology, The First Affiliated Hospital of University of South China, University of South China, Hengyang, 421001, China
| | - Fang-Fang Tan
- Department of Gastroenterology, The First Affiliated Hospital of University of South China, University of South China, Hengyang, 421001, China
| | - Hai-Na Xie
- Department of Gastroenterology, The First Affiliated Hospital of University of South China, University of South China, Hengyang, 421001, China
| | - Xue Fang
- Department of Gastroenterology, Changhai Hospital, Second Military Medical University, Yangpu District, Shanghai, 200433, China
| | - Shu-Ling Wang
- Department of Gastroenterology, Changhai Hospital, Second Military Medical University, Yangpu District, Shanghai, 200433, China
| | - Wei Fan
- Division of Digestive and Liver Diseases, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Jian-Yao Wang
- Department of Gastroenterology, The 2nd Clinical Medicine College (Shenzhen People's Hospital) of Jinan University, Shenzhen, 518020, China
| | - Zhi-Chao Yu
- Department of Gastroenterology, The 2nd Clinical Medicine College (Shenzhen People's Hospital) of Jinan University, Shenzhen, 518020, China
| | - Cheng Wei
- Department of Gastroenterology, The 2nd Clinical Medicine College (Shenzhen People's Hospital) of Jinan University, Shenzhen, 518020, China
| | - Feng Xiong
- Department of Gastroenterology, The 2nd Clinical Medicine College (Shenzhen People's Hospital) of Jinan University, Shenzhen, 518020, China
| | - Ting-Ting Liu
- Department of Gastroenterology, The 2nd Clinical Medicine College (Shenzhen People's Hospital) of Jinan University, Shenzhen, 518020, China
| | - Ming-Han Luo
- Department of Gastroenterology, The 2nd Clinical Medicine College (Shenzhen People's Hospital) of Jinan University, Shenzhen, 518020, China
| | - Li-Sheng Wang
- Department of Gastroenterology, The 2nd Clinical Medicine College (Shenzhen People's Hospital) of Jinan University, Shenzhen, 518020, China
| | - Zhao-Shen Li
- Department of Gastroenterology, Changhai Hospital, Second Military Medical University, Yangpu District, Shanghai, 200433, China
| | - Jun Yao
- Department of Gastroenterology, The 2nd Clinical Medicine College (Shenzhen People's Hospital) of Jinan University, Shenzhen, 518020, China
| | - Yu Bai
- Department of Gastroenterology, Changhai Hospital, Second Military Medical University, Yangpu District, Shanghai, 200433, China.
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24
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Marín-Gabriel JC, Romito R, Guarner-Argente C, Santiago-García J, Rodríguez-Sánchez J, Toyonaga T. Use of electrosurgical units in the endoscopic resection of gastrointestinal tumors. GASTROENTEROLOGIA Y HEPATOLOGIA 2019; 42:512-523. [PMID: 31326105 DOI: 10.1016/j.gastrohep.2019.04.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 03/31/2019] [Accepted: 04/05/2019] [Indexed: 12/18/2022]
Abstract
Electrosurgical units (ESUs) are indispensable devices in our endoscopy units. However, many endoscopists are not well-trained on their use and their physical bases are usually not properly studied or understood. In addition, comparative data concerning the settings that may be applied in different circumstances are scarce in the medical literature. Given that it is important to be aware of their strengths and risks, we conducted a review of the available information and research on this topic.
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Affiliation(s)
- José C Marín-Gabriel
- Department of Gastroenterology, Endoscopy Unit, High Risk GI Cancer Clinic, Research Institute, 12 de Octubre (i+12), "12 de Octubre" University Hospital, Complutense University of Madrid, Madrid, Spain.
| | - Raffaella Romito
- Department of Gastroenterology, Hospital de la Santa Creu i Sant Pau, Institut de Reçerca - IIB Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Carlos Guarner-Argente
- Department of Gastroenterology, Hospital de la Santa Creu i Sant Pau, Institut de Reçerca - IIB Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - José Santiago-García
- Department of Gastroenterology, Endoscopy Unit, "Puerta de Hierro-Majadahonda" University Hospital, Autonomous University of Madrid (UAM), Majadahonda (Madrid), Spain
| | - Joaquín Rodríguez-Sánchez
- Department of Gastroenterology, Endoscopy Unit, Hospital Universitario de Ciudad Real, Ciudad Real, Spain
| | - Takashi Toyonaga
- Department of Endoscopy, Kobe University Hospital, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Japan
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25
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Tang C, Choi JH. Novel evaluation method for electrosurgical ablation by monopolar hot biopsy forceps for colonoscopy. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2018; 11:379-389. [PMID: 30498377 PMCID: PMC6207088 DOI: 10.2147/mder.s181025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Aim This study evaluates tissue injury, which results from electrosurgical ablation, by correlating lesion depth to tissue impedance, and introduces a newly developed real-time feedback control system that can be applied for preventing excessive tissue injury. Although some previous studies had evaluated such tissue injuries in other ways, a specific mechanism is necessary to actually prevent excessive tissue injury. Materials and methods Ablation tests were performed by using an impedance bridge circuit and gel block that have been developed in two previous studies. Depth of the ablation site was measured with the use of a laser displacement measurement device. To simplify the programing work, voltage was used, as a substitution of tissue impedance, to evaluate tissue injury. Results The depth of the ablation site was found to increase with either increased power setting or ablation duration, and the depth was analyzed to investigate correlation with measured voltage. The real-time feedback control system was developed by achieving communication between LabVIEW and an Arduino microcontroller. Conclusion It is concluded that the depth of the ablation site modestly correlates with the measured voltage under specific conditions, and the newly developed system fulfills the goal of the design.
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Affiliation(s)
- Chen Tang
- Department of Mechanical Engineering, Ohio University Athens, Athens, OH 45701, USA
| | - Jung Hun Choi
- Department of Mechanical Engineering, Georgia Southern University, Statesboro, GA 30459, USA,
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26
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Ryozawa S, Itoi T, Katanuma A, Okabe Y, Kato H, Horaguchi J, Fujita N, Yasuda K, Tsuyuguchi T, Fujimoto K. Japan Gastroenterological Endoscopy Society guidelines for endoscopic sphincterotomy. Dig Endosc 2018; 30:149-173. [PMID: 29247546 DOI: 10.1111/den.13001] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 12/10/2017] [Indexed: 02/06/2023]
Abstract
The Japan Gastroenterological Endoscopy Society (JGES) has recently compiled guidelines for endoscopic sphincterotomy (EST) using evidence-based methods. Content regarding actual clinical practice, including detailed endoscopic procedures, instruments, device types and usage, has already been published by the JGES postgraduate education committee in May 2015 and, thus, in these guidelines we avoided duplicating such content as much as possible. The guidelines do not address pancreatic sphincterotomy, endoscopic papillary balloon dilation (EPBD), and endoscopic papillary large balloon dilation (EPLBD). The guidelines for EPLBD are planned to be developed separately. The evidence level in this field is often low and, in many instances, strong recommendation has to be determined on the basis of expert consensus. At this point in time, the guidelines are divided into six items including indications, techniques, specific cases, adverse events, outcomes, and postoperative follow up.
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Affiliation(s)
- Shomei Ryozawa
- Japan Gastroenterological Endoscopy Society, Tokyo, Japan
| | - Takao Itoi
- Japan Gastroenterological Endoscopy Society, Tokyo, Japan
| | - Akio Katanuma
- Japan Gastroenterological Endoscopy Society, Tokyo, Japan
| | | | - Hironari Kato
- Japan Gastroenterological Endoscopy Society, Tokyo, Japan
| | - Jun Horaguchi
- Japan Gastroenterological Endoscopy Society, Tokyo, Japan
| | - Naotaka Fujita
- Japan Gastroenterological Endoscopy Society, Tokyo, Japan
| | - Kenjiro Yasuda
- Japan Gastroenterological Endoscopy Society, Tokyo, Japan
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27
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Ishida T, Toyonaga T, Ohara Y, Nakashige T, Kitamura Y, Ariyoshi R, Takihara H, Baba S, Yoshizaki T, Kawara F, Tanaka S, Morita Y, Umegaki E, Hoshi N, Azuma T. Efficacy of forced coagulation with low high-frequency power setting during endoscopic submucosal dissection. World J Gastroenterol 2017; 23:5422-5430. [PMID: 28839443 PMCID: PMC5550792 DOI: 10.3748/wjg.v23.i29.5422] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 03/31/2017] [Accepted: 06/19/2017] [Indexed: 02/07/2023] Open
Abstract
AIM To investigated the hemostatic ability of the S and F1-10 methods in clinical and ex vivo studies.
METHODS The hemostatic abilities of the two methods were analyzed retrospectively in all six gastric endoscopic submucosal dissection cases. The treated vessel diameter, compressed vessel frequency, and bleeding frequency after cutting the vessels were noted by the recorded videos. The coagulation mechanism of the two power settings was evaluated using the data recording program and histological examination on macro- and microscopic levels in the ex vivo experiments using porcine tissues.
RESULTS F1-10 method showed a significantly better hemostatic ability for vessels ≥ 2 mm in diameter and a trend of overall better coagulation effect, evaluated by the bleeding rate after cutting the vessels. F1-10 method could sustain electrical current longer and effectively coagulate the tissue wider and deeper than the S method in the porcine model.
CONCLUSION F1-10 method is suggested to achieve a stronger hemostatic effect than the S method in clinical procedures and ex vivo models.
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28
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Kwon RS, Davila RE, Mullady DK, Al-Haddad MA, Bang JY, Bingener-Casey J, Bosworth BP, Christie JA, Cote GA, Diamond S, Jorgensen J, Kowalski TE, Kubiliun N, Law JK, Obstein KL, Qureshi WA, Ramirez FC, Sedlack RE, Tsai F, Vignesh S, Wagh MS, Zanchetti D, Coyle WJ, Cohen J. EGD core curriculum. VIDEOGIE : AN OFFICIAL VIDEO JOURNAL OF THE AMERICAN SOCIETY FOR GASTROINTESTINAL ENDOSCOPY 2017; 2:162-168. [PMID: 29905301 PMCID: PMC5991610 DOI: 10.1016/j.vgie.2017.03.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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29
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Affiliation(s)
- Suwan N. Jayasinghe
- BioPhysics Group, UCL Centre for Stem Cells and Regenerative Medicine; UCL Department of Mechanical Engineering and UCL Institute of Healthcare Engineering; University College London; Torrington Place London WC1E 7JE United Kingdom
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30
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Chandrasekhara V, Khashab MA, Muthusamy VR, Acosta RD, Agrawal D, Bruining DH, Eloubeidi MA, Fanelli RD, Faulx AL, Gurudu SR, Kothari S, Lightdale JR, Qumseya BJ, Shaukat A, Wang A, Wani SB, Yang J, DeWitt JM. Adverse events associated with ERCP. Gastrointest Endosc 2017; 85:32-47. [PMID: 27546389 DOI: 10.1016/j.gie.2016.06.051] [Citation(s) in RCA: 444] [Impact Index Per Article: 63.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 06/30/2016] [Indexed: 02/07/2023]
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31
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Suchanek S, Grega T, Zavoral M. The role of equipment in endoscopic complications. Best Pract Res Clin Gastroenterol 2016; 30:667-678. [PMID: 27931628 DOI: 10.1016/j.bpg.2016.09.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 08/17/2016] [Accepted: 09/06/2016] [Indexed: 01/31/2023]
Abstract
The role of the surrounding equipment in endoscopic complications has not been published widely. However, an adequate understanding of the advantages and disadvantages of such devices might be helpful to avoid unnecessary problems during endoscopy. This is an overview of the basic principles, benefits and possible harms of electrical power units, medical gases and vital sign monitoring equipment. The aim of this review is to summarize current knowledge about the approach to the electrosurgical unit settings; periprocedural precautions, minimizing the risk of interference between endoscopic equipment and other electrical devices; the appropriate selection of instruments regarding the electrosurgical outcome and the role of carbon dioxide, argon plasma coagulation, pulse oximetry and capnography.
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Affiliation(s)
- Stepan Suchanek
- Department of Internal Medicine, 1st Faculty of Medicine, Charles University, Military University Hospital, U Vojenske nemocnice 1200, Prague 6, 169 02, Czech Republic.
| | - Tomas Grega
- Department of Internal Medicine, 1st Faculty of Medicine, Charles University, Military University Hospital, U Vojenske nemocnice 1200, Prague 6, 169 02, Czech Republic.
| | - Miroslav Zavoral
- Department of Internal Medicine, 1st Faculty of Medicine, Charles University, Military University Hospital, U Vojenske nemocnice 1200, Prague 6, 169 02, Czech Republic.
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32
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Saunders BP, Tsiamoulos ZP. Endoscopic mucosal resection and endoscopic submucosal dissection of large colonic polyps. Nat Rev Gastroenterol Hepatol 2016; 13:486-96. [PMID: 27353401 DOI: 10.1038/nrgastro.2016.96] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Almost all large and complex colorectal polyps can now be resected endoscopically. Piecemeal endoscopic mucosal resection (PEMR) is an established technique with fairly low complication risk and good short-term and medium-term outcomes. Several modifications to the basic injection and snare technique have been developed contributing to safer and more complete resections. Delayed bleeding requiring reintervention is the most troublesome complication in 2-7% of patients, particularly in those with comorbidities and large, right-sided polyps. Endoscopic submucosal dissection (ESD) has become popular in Japan and has theoretical advantages over PEMR in providing a complete, en bloc excision for accurate histological staging and reduced local recurrence. These advantages come at the cost of a more complex, expensive and time-consuming procedure with a higher risk of perforation, particularly early in the procedure learning curve. These factors have contributed to the slow adoption of ESD in the West and the challenge to develop new devices and endoscopic platforms that will make ESD easier and safer. Currently, ESD indications are limited to large rectal lesions, in which procedural complications are easily managed, and for colorectal polyps with a high risk of containing tiny foci of early submucosally invasive cancer, whereby ESD may be curative compared with PEMR.
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Affiliation(s)
- Brian P Saunders
- Imperial College, London, Wolfson Unit for Endoscopy, St Mark's Academic Institute, Watford Road, Harrow HA1 3UJ, UK
| | - Zacharias P Tsiamoulos
- Imperial College, London, Wolfson Unit for Endoscopy, St Mark's Academic Institute, Watford Road, Harrow HA1 3UJ, UK
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Park HJ. Endoscopic Instruments and Electrosurgical Unit for Colonoscopic Polypectomy. Clin Endosc 2016; 49:350-4. [PMID: 27399313 PMCID: PMC4977736 DOI: 10.5946/ce.2016.059] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Revised: 06/12/2016] [Accepted: 06/23/2016] [Indexed: 11/14/2022] Open
Abstract
Colorectal polypectomy is an effective method for prevention of colorectal cancer. Many endoscopic instruments have been used for colorectal polypectomy, such as snares, forceps, endoscopic clips, a Coagrasper, retrieval net, injector, and electrosurgery generator unit (ESU). Understanding the characteristics of endoscopic instruments and their proper use according to morphology and size of the colorectal polyp will enable endoscopists to perform effective polypectomy. I reviewed the characteristics of endoscopic instruments for colorectal polypectomy and their appropriate use, as well as the basic principles and settings of the ESU.
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Affiliation(s)
- Hong Jun Park
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
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Moneghini D, Lipari A, Missale G, Minelli L, Cengia G, Bontempi L, Curnis A, Cestari R. Lack of interference between small bowel capsule endoscopy and implantable cardiac defibrillators: an 'in vivo' electrophysiological study. United European Gastroenterol J 2016; 4:216-20. [PMID: 27087949 PMCID: PMC4804376 DOI: 10.1177/2050640615608570] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 09/01/2015] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Capsule endoscopy is a widely performed procedure for small bowel investigation. Once swallowed by the patient, the capsule transmits images to an external recorder over a digital radiofrequency communication channel. Potential electromagnetic interferences with implantable cardiac devices have been postulated. Clinical studies on the safety of capsule endoscopy in patients with cardiac defibrillators are lacking. OBJECTIVE The aim of this study was to assess potential mutual electromagnetic interferences between capsule and defibrillators. METHODS This study used the Given M2A video capsule system. Ten different types of defibrillators were tested in a clinical setting. Before capsule ingestion, defibrillator electrical therapies were switched off. During capsule endoscopy patients were monitored with cardiac telemetry. At the end of capsule endoscopy the following defibrillator's parameters were analysed: change in device settings; inappropriate shocks; inappropriate anti-tachycardia therapy; inappropriate sensing or pacing; noise detection; device reset; programming changes; permanent electrical damages. Any technical problem related to capsule image transmission was recorded. RESULTS Neither defibrillator malfunction nor interference in sensing or pacing was recorded; conversely, no capsule malfunction potentially caused by defibrillators was registered. CONCLUSION Our results suggest that capsule endoscopy can be safely performed in patients with cardiac defibrillators.
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Affiliation(s)
- Dario Moneghini
- U.O. Chirurgia Endoscopica Digestiva, Spedali Civili, Brescia, Italy
| | - Alessandro Lipari
- Laboratorio di Elettrofisiologia ed Elettrostimolazione, Università degli Studi, Brescia, Italy
| | - Guido Missale
- U.O. Chirurgia Endoscopica Digestiva, Spedali Civili, Brescia, Italy
| | - Luigi Minelli
- U.O. Chirurgia Endoscopica Digestiva, Spedali Civili, Brescia, Italy
| | - Gianpaolo Cengia
- U.O. Chirurgia Endoscopica Digestiva, Spedali Civili, Brescia, Italy
| | - Luca Bontempi
- Laboratorio di Elettrofisiologia ed Elettrostimolazione, Università degli Studi, Brescia, Italy
| | - Antonio Curnis
- Laboratorio di Elettrofisiologia ed Elettrostimolazione, Università degli Studi, Brescia, Italy
| | - Renzo Cestari
- U.O. Chirurgia Endoscopica Digestiva, Spedali Civili, Brescia, Italy
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35
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Baeg MK, Kim SW, Ko SH, Lee YB, Hwang S, Lee BW, Choi HJ, Park JM, Lee IS, Oh YS, Choi MG. Endoscopic Electrosurgery in Patients with Cardiac Implantable Electronic Devices. Clin Endosc 2016; 49:176-81. [PMID: 26867552 PMCID: PMC4821527 DOI: 10.5946/ce.2015.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Revised: 04/19/2015] [Accepted: 05/11/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND/AIMS Patients with cardiac implantable electronic devices (CIEDs) undergoing endoscopic electrosurgery (EE) are at a risk of electromagnetic interference (EMI). We aimed to analyze the effects of EE in CIED patients. METHODS Patients with CIED who underwent EE procedures such as snare polypectomy, endoscopic submucosal dissection (ESD), and endoscopic retrograde cholangiopancreatography (ERCP) with endoscopic sphincterotomy (EST) were retrospectively analyzed. Postprocedural symptoms as well as demographic and outpatient follow-up data were reviewed through medical records. Electrical data, including preprocedural and postprocedural arrhythmia records, were reviewed through pacemaker interrogation, 24-hour Holter monitoring, or electrocardiogram. RESULTS Fifty-nine procedures in 49 patients were analyzed. Fifty procedures were performed in 43 patients with a pacemaker, and nine were performed in six patients with an implantable cardioverter-defibrillator. There were one gastric and 44 colon snare polypectomies, five gastric and one colon ESDs, and eight ERCPs with EST. Fifty-five cases of electrical follow-up were noted, with two postprocedural changes not caused by EE. Thirty-one pacemaker interrogations had procedure recordings, with two cases of asymptomatic tachycardia. All patients were asymptomatic with no adverse events. CONCLUSIONS Our study reports no adverse events from EE in patients with CIED, suggesting that this procedure is safe. However, because of the possibility of EMI, recommendations on EE should be followed.
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Affiliation(s)
- Myong Ki Baeg
- Division of Gastroenterology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sang-Woo Kim
- Division of Gastroenterology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sun-Hye Ko
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yoon Bum Lee
- Division of Gastroenterology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seawon Hwang
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Bong-Woo Lee
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hye Jin Choi
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jae Myung Park
- Division of Gastroenterology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - In-Seok Lee
- Division of Gastroenterology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yong-Seog Oh
- Division of Cardiology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Myung-Gyu Choi
- Division of Gastroenterology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Abstract
This article provides an overview of the evaluation and management of lower gastrointestinal bleeding (LGIB) in children. The common etiologies at different ages are reviewed. Conditions with endoscopic importance for diagnosis or therapy include solitary rectal ulcer syndrome, polyps, vascular lesions, and colonic inflammation and ulceration. Diagnostic modalities for identifying causes of LGIB in children include endoscopy and colonoscopy, cross-sectional and nuclear medicine imaging, video capsule endoscopy, and enteroscopy. Pre-endoscopic preparation and decision-making unique to pediatrics is highlighted. The authors conclude with a summary of current and emerging therapeutic hemostatic techniques that can be used in pediatric patients.
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Affiliation(s)
- Benjamin Sahn
- Division of Pediatric Gastroenterology & Nutrition, Steven & Alexandra Cohen Children's Medical Center of New York, Hofstra North Shore-LIJ School of Medicine, North Shore - Long Island Jewish Health System, 1991 Marcus Avenue, Suite M 100, New Hyde Park, NY 11042, USA.
| | - Samuel Bitton
- Division of Pediatric Gastroenterology & Nutrition, Steven & Alexandra Cohen Children's Medical Center of New York, Hofstra North Shore-LIJ School of Medicine, North Shore - Long Island Jewish Health System, 1991 Marcus Avenue, Suite M 100, New Hyde Park, NY 11042, USA
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37
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Song LMWK, Gostout CJ, Tucker RD, Morris ML, Bowers WJ, Cattau EL. Electrosurgery in gastrointestinal endoscopy: terminology matters. Gastrointest Endosc 2016; 83:271-3. [PMID: 26264432 DOI: 10.1016/j.gie.2015.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Accepted: 08/04/2015] [Indexed: 02/08/2023]
Affiliation(s)
| | - Christopher J Gostout
- Division of Gastroenterology and Hepatology, Developmental Endoscopy Unit, Mayo Clinic, Rochester, Minnesota, USA
| | - Robert D Tucker
- Department of Pathology, University of Iowa, Iowa City, Iowa, USA
| | - Marcia L Morris
- Chief Executive Officer, Genii, Inc., St. Paul, Minnesota, USA
| | - William J Bowers
- Vice President and Principal Engineer, Cintron Medical Corporation, Westminster, Colorado, USA
| | - Edward L Cattau
- Medical Director, ASC Gastro One, Germantown, Tennessee, USA
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Abstract
Electrosurgery allows both cutting and coagulation of tissue and is an essential tool for therapeutic endoscopy. Electrosurgery is also the most commonly used and misunderstood technology by all surgical and medical disciplines. In other words, everyone uses it, but few understand it! The aims of this article are to (1) present a useful review of the fundamentals of electrosurgery technology; (2) relate the fundamentals to commonly performed flexible endoscopy procedures; and (3) provide a review of the safe application of grounding pads, careful management of accessories, and special patient safety considerations.
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39
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Burgess NG, Bahin FF, Bourke MJ. Colonic polypectomy (with videos). Gastrointest Endosc 2015; 81:813-35. [PMID: 25805461 DOI: 10.1016/j.gie.2014.12.027] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Accepted: 12/04/2014] [Indexed: 02/08/2023]
Affiliation(s)
- Nicholas G Burgess
- Department of Gastroenterology and Hepatology, Westmead Hospital; Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Farzan F Bahin
- Department of Gastroenterology and Hepatology, Westmead Hospital; Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Michael J Bourke
- Department of Gastroenterology and Hepatology, Westmead Hospital; Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
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Prabhu NC, Song LMWK. Achieving hemostasis and the risks associated with therapy. Gastrointest Endosc Clin N Am 2015; 25:123-45. [PMID: 25442963 DOI: 10.1016/j.giec.2014.09.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Acute gastrointestinal bleeding is a common cause for hospitalization. Endoscopic hemostasis plays a central role in the management of lesions with active bleeding or high-risk stigmata for rebleeding. The efficacy and safety of endoscopic hemostasis rely on the identification of lesions suitable for endoscopic therapy, selection of the appropriate hemostatic devices, attention to technique, and prompt recognition and management of procedure-related adverse events. In this article, practical applications of hemostatic devices and pitfalls related to endoscopic hemostasis are discussed.
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Affiliation(s)
- Nayantara Coelho Prabhu
- Division of Gastroenterology and Hepatology, Mayo Clinic, 200 1st Street Southwest, Rochester, MN 55905, USA
| | - Louis M Wong Kee Song
- Division of Gastroenterology and Hepatology, Mayo Clinic, 200 1st Street Southwest, Rochester, MN 55905, USA.
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41
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Sethi A, Song LMWK. Adverse events related to colonic endoscopic mucosal resection and polypectomy. Gastrointest Endosc Clin N Am 2015; 25:55-69. [PMID: 25442958 DOI: 10.1016/j.giec.2014.09.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Colonoscopy is a commonly performed procedure. The rate of adverse events is 2.8 per 1000 screening colonoscopies. These adverse events include cardiovascular and pulmonary events, abdominal pain, hemorrhage, perforation, postpolypectomy syndrome, infection, and death. Serious adverse events, such as hemorrhage and perforation, occur most frequently when colonoscopy is performed with polypectomy. This article highlights the prevention and management of adverse events associated with polypectomy and endoscopic mucosal resection of colonic lesions.
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Affiliation(s)
- Amrita Sethi
- Division of Digestive and Liver Diseases, Columbia University, 161 Fort Washington Avenue, Herbert Irving Pavilion, Suite 862, New York, NY 10032, USA.
| | - Louis M Wong Kee Song
- Division of Gastroenterology and Hepatology, Mayo Clinic, 200 1st Street Southwest, Rochester, MN 55905, USA
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42
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Artificial hand for minimally invasive surgery: design and testing of initial prototype. Surg Endosc 2014; 29:61-7. [DOI: 10.1007/s00464-014-3657-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Accepted: 04/11/2014] [Indexed: 10/25/2022]
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Coleman KA, Berent AC, Weisse CW. Endoscopic mucosal resection and snare polypectomy for treatment of a colorectal polypoid adenoma in a dog. J Am Vet Med Assoc 2014; 244:1435-40. [DOI: 10.2460/javma.244.12.1435] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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44
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Easley JT, Hendrickson DA. Advances in laparoscopic techniques and instrumentation in standing equine surgery. Vet Clin North Am Equine Pract 2014; 30:19-44. [PMID: 24680205 DOI: 10.1016/j.cveq.2013.11.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Equine standing surgery and laparoscopy are becoming increasingly important aspects of equine surgery. Laparoscopic advancements lag behind the human medical field, mainly due to decreased access to appropriate training and instrumentation. It is nearly impossible to cover the topic of equine standing surgery without discussing advances in laparoscopy, because without such advances, equine standing surgery lacks potential for forward progress. Although novel standing techniques continue to be published, the addition of minimally invasive laparoscopic techniques adds an entirely new dimension and provides a plethora of procedures to surgeons practicing equine standing surgery.
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Affiliation(s)
- Jeremiah T Easley
- Surgical Research Laboratory, Department of Clinical Sciences, Colorado State University, 300 W Drake Road, Fort Collins, CO 80523, USA.
| | - Dean A Hendrickson
- Professional Veterinary Medicine, Colorado State University, 300 W Drake Road, Fort Collins, CO 80523, USA
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45
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Abstract
The value of performing comprehensive screening colonoscopy with complete colon polypectomy is widely accepted. Colon cancer is a significant cause of worldwide mortality and prospective studies have proven that colonoscopic polypectomy reduces both the incidence and mortality related to this disease. Over the past few decades the array of instruments and techniques have greatly expanded to assist with the safe endoscopic removal of colon polyps. This article will review the published literature regarding efficacy and safety of standard polypectomy techniques such as snare polypectomy, electrocautery, and endoscopic mucosal resection along with newer techniques such as endoscopic submucosal dissection and combined laparoscopic techniques.
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46
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Tokar JL, Barth BA, Banerjee S, Chauhan SS, Gottlieb KT, Konda V, Maple JT, Murad FM, Pfau PR, Pleskow DK, Siddiqui UD, Wang A, Rodriguez SA. Electrosurgical generators. Gastrointest Endosc 2013; 78:197-208. [PMID: 23867369 DOI: 10.1016/j.gie.2013.04.164] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Accepted: 04/03/2013] [Indexed: 02/08/2023]
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47
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Fahrtash-Bahin F, Holt BA, Jayasekeran V, Williams SJ, Sonson R, Bourke MJ. Snare tip soft coagulation achieves effective and safe endoscopic hemostasis during wide-field endoscopic resection of large colonic lesions (with videos). Gastrointest Endosc 2013; 78:158-163.e1. [PMID: 23570622 DOI: 10.1016/j.gie.2013.02.030] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2012] [Accepted: 02/20/2013] [Indexed: 02/07/2023]
Abstract
BACKGROUND Wide-field EMR (WF-EMR) of large colonic lesions exposes submucosal vessels, which may result in intraprocedural bleeding (IPB). Ongoing bleeding may obscure the endoscopic field, prolonging the procedure and reducing safety and accuracy. A number of potential interventions to control bleeding exist; however, they have inherent limitations. Safe, readily applicable, inexpensive, and effective therapy to control EMR-IPB has not yet been described. OBJECTIVE To evaluate the safety and efficacy of the snare tip soft coagulation (STSC) technique to control IPB after WF-EMR of large colonic lesions. DESIGN Single-center, prospective cohort study. SETTING Tertiary care referral center. PATIENTS A total of 196 patients undergoing wide-field colonic EMR for flat and sessile lesions 20 mm or larger. INTERVENTIONS A standard inject-and-resect EMR technique was applied. IPB was defined as bleeding obscuring the endoscopic field that persisted for 60 seconds or longer. STSC was performed by using the tip of the polypectomy snare to apply soft coagulation (80 W) to sites of IPB. MAIN OUTCOME MEASUREMENTS Immediate hemostasis, postprocedural bleeding, and other adverse events. RESULTS A total of 198 lesions (mean size 41.5 mm, 64% in the right colon) were removed in 196 patients (mean age 68 years, 52.5% male). STSC alone achieved effective hemostasis in 40 of 44 cases of IPB (91%). In the remaining 4 cases, additional treatment with coagulating forceps or clips was required to achieve hemostasis. There were no immediate STSC-related adverse events. There was no statistically significant difference between the IPB and non-IPB groups in relation to the use of antiplatelet (P = .2) or anticoagulation agents (P = .4), postprocedural bleeding (P = .8) and adverse event rates (P = .7). LIMITATIONS Nonrandomized study. CONCLUSIONS STSC is a simple and efficient first-line technique for achieving hemostasis of IPB during WF-EMR in the colon. It succeeds in the majority of cases and appears to be safe.
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Affiliation(s)
- Farzan Fahrtash-Bahin
- Department of Gastroenterology and Hepatology, Westmead Hospital, Westmead, Sydney, New South Wales, Australia
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48
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Liu F, Liu J, Li Z. New role of the dual knife for precut papillotomy in difficult bile duct cannulation. Dig Endosc 2013; 25:329-32. [PMID: 23368726 DOI: 10.1111/j.1443-1661.2012.01358.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2012] [Accepted: 06/14/2012] [Indexed: 02/08/2023]
Abstract
The dual knife is usually used for endoscopic submucosal dissection (ESD). To date, however, there have been no clinical trials of the safety and effectiveness of precut papillotomy using the dual knife for biliary access in patients failing conventional endoscopic retrograde cholangiopancreatography (ERCP) cannulation. We herein report 18 patients who underwent precut papillotomy with the dual knife. All had intact papilla, and had failed deep cannulation of the bile ducts. After successful biliary cannulation and standard endoscopic sphincterotomy, if necessary, stone removal or plastic or metal stent insertion was attempted. Selective bile-duct cannulation was achieved in all 18 patients (100%), at an average time of 4.2 min (range, 3-6 min). Of these 18 patients, six had malignant bile duct obstruction and 12 had common bile duct stones. One patient developed post-ERCP pancreatitis, which resolved after conservative management. There were no deaths related to the procedure.
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Affiliation(s)
- Feng Liu
- Department of Gastroenterology, Changhai Hospital, Second Military Medical University, Shanghai 200433, China.
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49
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Andreu N, Thomas D, Saraiva L, Ward N, Gustafsson K, Jayasinghe SN, Robertson BD. In vitro and in vivo interrogation of bio-sprayed cells. SMALL (WEINHEIM AN DER BERGSTRASSE, GERMANY) 2012; 8:2495-2500. [PMID: 22648794 DOI: 10.1002/smll.201200138] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2012] [Revised: 03/06/2012] [Indexed: 06/01/2023]
Abstract
Bio-sprays can directly form pre-organized cell-bearing structures for applications ranging from engineering functional tissues to the forming of cultures, most useful for modeling disease, to the discovery and development of drugs. Bio-electrosprays and aerodynamically assisted bio-jets, are leading approaches that have been demonstrated as having far-reaching ramifications for regenerative biology and medicine.
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Affiliation(s)
- Nuria Andreu
- Centre for Molecular Medicine & Infection, Department of Medicine, Flowers Building, Imperial College London, South Kensington, London SW7 2AZ, United Kingdom
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50
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Tse F, Yuan Y, Moayyedi P, Leontiadis GI. Electrosurgical current for endoscopic biliary sphincterotomy (EBS) for the prevention of post endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis. Hippokratia 2012. [DOI: 10.1002/14651858.cd009643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Frances Tse
- McMaster University; Department of Medicine, Division of Gastroenterology; 1200 Main Street West 2F8-53 Hamilton Ontario Canada L8N 3Z5
| | - Yuhong Yuan
- McMaster University; Department of Medicine, Division of Gastroenterology; 1200 Main Street West 2F8-53 Hamilton Ontario Canada L8N 3Z5
| | - Paul Moayyedi
- McMaster University; Department of Medicine, Division of Gastroenterology; 1200 Main Street West 2F8-53 Hamilton Ontario Canada L8N 3Z5
| | - Grigorios I Leontiadis
- McMaster University; Department of Medicine, Division of Gastroenterology; 1200 Main Street West 2F8-53 Hamilton Ontario Canada L8N 3Z5
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